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COMPANY OR

EMPLOYER NAME:__ harvard _ POSITION APPLIED FOR: Teacher ______

Employment Application APPLICANT


76-08_
TELEPHONE: 59-92-
SOCIAL SECURITY
NUMBER: ________
YOUR NAME: ____Montoya _____ Merida Laritza ______
Last First Middle
ARE YOU LEGALLY ELIGIBLE FOR EMPLOYMENT IN
ADDRES: THE U.S.A? . Yes No
#6, Porfirio Díaz st., Villa ___ (if yes, verification will be required)
_Sol, México ________
I AM SEEKING A PERMANENT POSITION: Yes
Are you able to perform the essential functions
No IF NECESSARY FOR THE JOB I AM ABLE TO:
of the position with or without accommodations?
Work (which shifts)? Select: yes_
Yes No _____________________ work over
time? Select: yes__________ ___________
IF NECESSARY FOR THE JOB, ARE YOU OVER Provide(Please
a validmark one)
Alaska drivers14_ 15_ 16_ 18
license?
x 19_ 21_
I WILL BE ABLE TO REPORT TO WORK 1 DAYS AFTER BEING NOTIFIED THAT I AM HIRED
EDUCATION: Yrs. Completed Field
of study Graduate of degree
High school official Anexa a la Normal de Atizapan 3
General Graduate____
University Normal Superior de México 5 Social
Sciences Degree_______
Business/Technical
_
Other (may include grammar school)
MILITARY SERVICE: Yes No
Duty/specialized Training:

REFERENCES: List two personal references who are not relatives or former supervisors.
Rosalia Mendoza #18, Porfirio Diaz st., Villa Sol 59-12-16-24
Seller 6
Name Address Telephone
Occupation Years Known
Alejandra Silva #8, Independencia st., Elm 28-61-36-80
Teacher 10
Name Address Telephone
Occupation Years Known

EMPLOYMENT: List last employment first. Include summer or temporary jobs. Be sure all your
experience or employers related to this job are listed here in the summary (following this
section), or use an extra sheet of paper if necessary
Employer name and Position title/Duties Skills Dates employed
address From to
Teacher 13/ may/2000
School Andres Molina
17/March/2006
E.
126 Jardines st., Reason for leaving
Mexico Change of Residence
Supervisor´s Name Telephone:
Jose Alberto Rodriguez 45-17-09-21
Employer name and Position title/Duties Skills Dates employed
address From 18/March/2006
Teacher to 25/ May/2010
School Sor Juana Inés
de
La Cruz, 240, Siempre Reason for leaving
Sexual harassment
Vivas st., Mexico Supervisor´s Name

Developed at employer request by the Alaska Department of Labor and Workforce Development, Employment Security
Division.

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